3

Ignording or suppressing the thougth of death, including any associated anxiety

common defense mechanism and coping strategy whereby one pushes something out of consciousness

A “giving in” and realizing of the inevitablity of death

being psychologically prepard for the final exit

both cognitive and emotional

People with this attitude feel truly positive about death and may even look forward to its occurrence

I've lived long enough, and I don't want to have my life extended. I know it'sawful, but I'd like to go to sleep and not wake up. I know that's a shock to thefamily, but it's great for the person concerned.” (Beryl at age 95)

People with this attitude accept the inevitability of death; they neither look forward to it nor fear its occurrence.

“Life in prison isn't a life, this isn't living, man. It's just surviving.”“If people say they're going to kill me, get to it.”

People with this attitude welcome theend of life and view death as an escapefrom pain and suffering

“If I go through with it, I die, as I must at some point. If I don't go through with it, mychoice is essentially to suffer and to inflict suffering on my family, and then die,possibly in a way that is considerably more stressful and painful than this way. I'vegot death. I've got suffering and death. Well gee, you know, this makes a whole lot ofsense to me.”

Temporary shock resonse in which the person does not believe or accept what is happening

• used by nearly all patients in some form

• often leads to isolation from friends/family

CAN serve an important function, normal, healthy, adaptive

• diagnosis denial in 4-47%, impact denial in 8-70% of cancer patients

may be used as sole defence, or ill or dying people may engage in partial denial

Feelings of frustration nd resentment

• different expressions

• can be towards deity, universe, others…

A brief stage involving irrational attempts to postpone death

• often involves conversation with deity or universe

• difficult to study

“Please God, let me live to see my daughter graduate.”

Feelings of sadness, despair and helplessness, a grieving over one’s losses and empending death

• reactive depression (past losses) - job, hobbies, mobility

• Preparator depression (losses to come) - familiy, relationships

Typically the longest stage - many never move onto the next

25-77% incidence rate in terminally ill patients

A “giving in” and realizing of the inevitability of death, often neither happy nor sad, sometimes void of feelings

According to Kübler-Ross,when people are given somehelp with the process, most areable to achieve a peacefulresolution with their lives.

• range of reactions to death, dispelling the myth that there is a single appropriate response

• has broken down social/cultural barriers and taboos

• allows counsellors to identify needs

• did not consider pre-existing literature

• no evidence for order and universality of the 5 stages

• may be interpreted as the “right way” to die

Within clinical setting

• may be normative, move patients along with goal of acceptance

• result in attempts to control/ manage dying process

• lead to labelling of some patients as good based on their trajectory —> making others feel guilty

Qualitative study

denial and acceptance fluctuate

interdependent coping strategies

denial can serve as temporary safety net to preserve self-esteem, maintain relationships, prevent chaos at certain points in dying process

Evidence that denial is more common early on and acceptance more common closer to death

Pattison 1977: 3 stages of living-dying interval

1. Acute Phase: Fear and anxiety at peak

2. Chronic Living-Dying Phase: anxiety reducd, uestions about the unknown are asked, acceptance begins

3. Terminal Phase: imminent death is finally accepted, person withdraws emotionally and socially

Shnetdman (1980) , levels of death work a person must complete

1. Psychological: preparing to meet one’s end and coming to terms with dying

2. Social: enabling oneself to help loved ones in the preparation for their survival

Weisman & Hackett (1961): Suggested 4 main requirements for the person dying:

1. Reduction of conflicts (inner & outer)

2. Compatibility with ego ideal

3. Continuity of relationships is preserved & restored

4. Fulfilment of prevailing wishes

Given a little choice and autonomy, what death would be bestfor us, the death most consistent with the values and aims wehave followed throughout life?” (Weisman)

Behaviour that explores the limits of safety and convention, voluntary risk-taking

involves material practices (doings), embodied experiences (sensations), supporting structures

danger, excitement and control are key

Used to analyze:

• academic career risk-taking

• extreme ritual performances

• negotiating violent domestic relationships

• pro-anorexia subculture —-

NDEs involve a variety of sensations reported by people who have died and been brought back to life, and by people who have come close to death

• hearing someone pronounce them dead

• feelings of peace

• travelling through a dark space or tunnel

• seeing a review of their life

8% of Americans have died and regained consciousness or come close to death, 35% of those reported NDEs

Criss-Cultural evidence of NDEs (5-48% of adults and 85% of childen )

Brain dos not shut down as quickly when heart stops beating

hyper state of perceptual neural activity

Brain regions: Amygdala, Hippocampus, Cortex

NDEs are very similar to drug-induced hallucinations, but not identical

Ketamine most similar, followed by psychedelics

Most NDEs have a significant positive and lasting impact

• new sense of meaning & purpose

• loss of fear of death

• new or renewed belief in afterlife

• new sense of self, increased self-esteem

• more open, caring and loving

Reminiscence – Volitional and non-volitional act of recollectingmemories of one’s self in the past (Bluck & Levine, 1998).

Some functions are maladaptive (Cappeliez & O’Rourke, 2006).In a study of nursing home residents, a reminiscence groupdemonstrated improvements in depression and loneliness aftersharing memories, life events, family history, and personalaccomplishments (Franck et al., 2016).

Life Review – Return of memories and past conflicts at end of life;spontaneous or structured evaluation/reconciliation of one’s life

1. Biological (genetic means, children)

2. Creative (arts, teaching, mentoring)

3. Transcendental (spiritual, religious beliefs)

4. Natural (sense of connectedness to nature/ earth)

5. Experiential transcendences (psychich state - one so intense and all-encompassing that time and death disappear)

Correlated with purpose in life and reduced fear of death

Not only dies symbolic immortality give life meaning, if also ensures our continued symbolic connection to others after we dies

Guiding the next generation (vs. stagnation)

Involves generative concern for next generation, resulting from social/ cultural pressures as well as internal desires for symbolic immortality

in old age, continuing generative concern is partly dependent on the attitudes and respect of younger generations

guiding, giving back, making a difference, taking care

Religiosity: Endorsing or subscribing to an organized system of beliefs, practices, rituals and symbols

Extrinsic ( self-serving, external) and intrinsic (Meaning-based and altruistic)

Large amount of research suggests that only intrinsic religiosity is significantly related to meaning in life

Spirituality: A “personal quest for understanding answers toultimate questions about life, about meaning, and aboutrelationship to the sacred or transcendent”

Highest risk in traumatic brain injuries, sleep disorders and HIV, 17 conditions were associated with increased risk

Thinking about, considering or planning suicide

Risk factor for suicide, but most people who have suicidal thoughts do not attempt suicide

1. Mental Illness

2. Other pssych factors (gried, isoltion)

3. Life Events (incl. ilness)

4. Gender

5. Age (highest rates in middle-aged men and women (35 to 59) and older men (60+)

6. Ethnicity, minority status and income elvel